Healthcare Provider Details

I. General information

NPI: 1932064581
Provider Name (Legal Business Name): WEATI PUNNI M.S., LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 TAMARACK CIR
SKILLMAN NJ
08558-2021
US

IV. Provider business mailing address

255 STATE ROUTE 18 UNIT 373
EAST BRUNSWICK NJ
08816-2065
US

V. Phone/Fax

Practice location:
  • Phone: 609-359-2266
  • Fax:
Mailing address:
  • Phone: 603-443-3768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number097.0136776
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC01000100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: